Project Summary In 2018, more than 1.7 million Americans will receive a new cancer diagnosis and nearly 600,000 will die from their disease. Cancer treatments, including major surgical resection and palliative chemotherapy, are associated with frequent adverse symptoms. The primary burden for managing symptoms falls on patients and their caregivers, and there is ample evidence that untreated symptoms impair quality of life, lead to inefficient use of emergency care, avoidable hospitalizations, and even shorten survival. Electronic tracking of patient- reported outcomes (ePROs) between face-to-face clinic visits has been shown to both reduce symptom burden and decrease the need for acute care. Although there is abundant evidence that symptom monitoring can improve cancer care, current experience has been largely limited to single centers or as part of clinical trials. Using ePROs to facilitate symptom control is an attractive strategy but, evidence for effectiveness in different treatment contexts and across varied populations is needed. Further, ePRO tracking systems have not been fully integrated into health systems' electronic health records (EHR) and this deficit prevents them from delivering the maximal benefits of proactive symptom management. To fill gaps in the evidence base about the optimal strategy for deploying ePROs, a multidisciplinary team from 6 health systems have formed the Symptom Management IMplementation of Patient Reported Outcomes in Oncology (SIMPRO) Research Center. SIMPRO's overarching goal is to develop, implement, and evaluate a multi-component ePRO reporting and management system to improve symptom control for patients recovering from cancer surgery or patients receiving palliative chemotherapy in small, rural, and community cancer centers. The Specific Aims of the project are to: (1) Adapt existing ePRO symptom management systems and integrate them into the EHR and routine clinical workflow at six health systems; (2) Determine the effectiveness of an EHR-integrated ePRO symptom management system on health outcomes; and (3) Evaluate the facilitators and barriers to implementation of an EHR-integrated ePRO symptom management system from the patient, clinical and organizational perspectives. Following the adaptation of operational ePRO prototypes and full integration into an EHR, the SIMPRO investigators will conduct a pragmatic cluster randomized trial with stepped wedge rollout to investigate the effectiveness of a symptom monitoring system from a patient, clinician and health system perspective. Across all study phases, the implementation process itself, including ePRO adoption, appropriateness, acceptability, penetration/scalability, and adaptation, will be critically evaluated. This approach will create knowledge that can be used to guide dissemination of ePROs and other interventions to improve cancer care delivery.